Wednesday, June 1, 2011

The Struggle to Succeed

"Genius is one percent inspiration and ninety nine percent perspiration."  -- Thomas Alva Edison

"Eighty percent of success is just showing up."  -- Woody Allen

Learning to tolerate frustration is one of the most important lessons a child can learn, and one of the hardest.  Children who can't deal with frustration, who don't have the inner capacity to sit with themselves and struggle, have a difficult time in many areas of life.   They don't feel good about themselves or have confidence in their abilities.

Children who can't deal with frustration can't wait for others to finish speaking before interrupting.  They can't take turns, they can't share, they can't apply themselves when it's time to learn a new skill.   They can't defer immediate gratification and take the long view.

They give up on themselves before they even begin, and develop all kinds of dysfunctional strategies to deflect others from forcing them to do things at which they think they won't be able to succeed.  They show up late or not at all, they talk a mile a minute, they have temper tantrums and claim that they have a tummy ache, they are too tired, it's too boring, it's too stupid, you are stupid for making them do it, it doesn't apply to real life and there's no point.  They are masters at being snarky and off putting, and dishing out attitude or indifference, until their teachers just give up on them and leave them alone.

In my clinical opinion, some of this is nature and some of this is nurture.  Nature consists of delays in the child's neurological development, which makes learning new skills so difficult that instead of struggling to master a skill and then succeeding, which motivates him to go on, the child fails and fails and fails until he is forced to give up.  Without enough success, the inner spark, which drives development forward, flickers out.

The nurture part is parents who don't assume the alpha position, allowing the child to run the show.  They give in to every whim,  don't insist on good manners like being respectful of others, waiting,  taking turns, sharing, and not interrupting.  They don't work with the child to help him form the internal resources that allow him to self soothe, self regulate, and to defer gratification.

Whenever I evaluate a child, one of the big things I am looking for is how hard the child is willing to push himself and how interested he is in impressing me.  Even if the child seems severely impaired, if he doesn't give up easily when I challenge him to do something beyond his present abilities, or if he can self regulate enough to get through a long, rigorous evaluation in one shot {my evaluations can last upwards of three hours} I can be quite optimistic about how much our work together will be able to do for him.  Over the years I have found that it's the inner drive to succeed, and the  willingness to struggle and do what it takes to get there, that is one of the best predictors of success.  If a child gives up easily, complains incessantly of boredom during an evaluation or challenging activity and needs constant redirection, or does not appear interested in pleasing the grownups, I have my work cut out for me. Before I can begin to do anything to help the child, I have to figure out how I'm going to get that inner fire lit.

About this time last year, I started working with a little boy who was referred for occupational therapy because he was constantly endangering himself and his classmates.  He was not mean, but he could not control his behavior at school.  He bit, kicked, threw things at people, slammed other children against the wall, could not sit still or attend for more than a minute or two, and was so disruptive that that the assistant teacher was basically serving as his one on one companion.  

Testing revealed that his gross and fine motor skills were significantly delayed, his balance was poor, he was severely auditory defensive, and  his visual motor coordination abilities were about eighteen months below his chronological age.

Despite all the defensiveness, delays and resulting behavioral issues, I was very optimistic about what we could accomplish together.  Although sitting still for the extensive battery of tests I put him through was tremendously challenging for him, he managed to push himself through all of it, even calling to my attention the fact that we had not finished the visual perceptual evaluation that I had set aside when he could not sit still for another minute.  He insisted on completing the entire thing, and was not satisfied until I reassured him that he had done everything that was expected of him and told him he had done a good job.

It's only a year later, he's completely caught up, his behavior at school is no longer an issue, and he is ready to graduate OT.  

What made this remarkable improvement possible so quickly? In my clinical opinion, it was because this child, underneath his sensory issues and neurological delays, had a strong work ethic and a sincere desire to please.

 During the year we worked together, he pushed himself relentlessly to meet every challenge that I set out for him, sometimes falling off the suspended equipment over and over until he learned how to motor plan an obstacle course without losing his balance.  Some things he hated and complained about, but he never gave up until he had mastered them.  

Despite his impairments, this child was easy to help because he was so driven to succeed and to impress grown ups.

I'll also never forget a little girl who set out a challenge for herself in the sensory gym which I privately thought was impossible.  She struggled and struggled and would not allow me to modify it in any way, shrugging me off impatiently if I tried to step in.  I sat there and watched, cheering silently, biting my nails, until she had swung by a rope from the top of the loft onto a swing suspended halfway across the room, and I will never forget the jubilation she experienced, crying," I DID IT!  I DID IT!"  This child walked out of the gym with a confidence and swagger that were something to see.  

In the clinic, I use crafts to teach problem solving, attention to detail, eye hand coordination, sitting tolerance, and deferred gratification.  A child's ability to sit still, attend, and apply himself to the task at hand can improve dramatically when he is involved in a purposeful, meaningful activity.  Games can be used to teach social skills like turn taking, being a member of a team, and sportsmanship. 

Interestingly, a child's strength and muscle tone have a great deal to do with his ability to "hang in there."  I see this all the time.  Weak, low tone children who literally can't hang on to the equipment can't seem to hang on in life, either.  It takes much convincing on my part to get them to keep going when they would rather give up on themselves and accept failure.

Parents can help by making sure the child gets plenty of time outside to develop motor skills and core strength, insisting on good manners, not giving in to every whim, and by helping the easily frustrated child by breaking down tasks into manageable parts so that they don't get overwhelmed.

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